This bill, the Hospice CARE Act of 2026, changes many rules about Medicare-funded hospice care. Major actions include a 5-year nationwide temporary moratorium on enrollment of new hospice programs (with limited exemptions for areas that lack access). The bill expands and requires more prepayment medical review for certain hospices and services, revalidates and publishes hospice ownership information, and requires a report on ownership trends including private equity. It lengthens enhanced oversight for new hospices, increases survey frequency for certain hospices, and gives the Secretary authority to impose civil monetary penalties for some violations.
The bill changes clinical and certification rules. It allows physician assistants and nurse practitioners to certify terminal illness, requires that some recertifications include a face-to-face visit within 30 days before recertification, and requires hospice medical reviewers to receive specialized instruction on hospice care. It also adds requirements for medical director availability and limits on how many programs one medical director may serve (with a waiver process).
On payments and services, the bill phases in a new hospice payment structure for routine home care (a per diem plus a per-visit component) starting in fiscal year 2030 and 2031, creates higher day rates for certain specified palliative services furnished 10/1/2027–9/30/2032, updates cap and wage-adjustment calculations, allows additional outlier payments for unusual routine home care, and adds new payment rules for short-term home respite care. The bill also requires plan-of-care steps when specified palliative services are included and adds rules about items and services unrelated to the terminal condition being subject to medical review before payment.
Other consumer protections include requiring a written explanation of benefits within 15 days of a hospice election that lists the hospice, contact numbers, the certifying clinician, and fraud-reporting instructions. The bill adds requirements for advance notice of ownership or management changes, an addendum to hospice election forms listing items not related to the terminal condition, and a GAO report on oversight of hospice accrediting organizations.
The bill text frames these provisions as steps to "ensure the integrity of hospice care." Provisions in the bill are aimed at improving oversight, increasing transparency of hospice ownership and control, strengthening medical review and audit processes, protecting beneficiaries with clear written election information, and aligning payment rates with the types and costs of services provided.
No publicly available information.